Oakhill Surgery

Updated 21 November 2016

Oakhill Surgery is located at Shepton Road, Oakhill, Radstock BA3 5HT. The practice is serving Oakhill and the surrounding villages. The patient list size is over 2800 and the practice’s population’s score of deprivation is 7 on a scale of one to ten where ten is the least deprived decile. The practice has a below average population of the age between 20 to 40 but has a higher than average teenage population due to supporting a local school. The practice provides its services under a General Medical Services (GMS) contract.

The practice’s current premises were built in 1991. In 2016 the building was extended by a consultation room, treatment room, new toilet facilities for those with disabilities, with baby changing facilities and a lift installed. The car park was also extended listening and responding to the ongoing feedback the practice had received from patients.

At the time of our inspection the practice’s staff included:

• 2 GP partners (two females) 1 WTE
• 1 GP trainee (male) 0.92 WTE
• 1 Practice Manager 0.75 WTE
• 3 part time reception staff 1.68 WTE
• 1 medical secretary 0.48 WTE
• 4 part time pharmacy dispensers 2.25 WTE
• 1 full time HCA/admin 0.96 WTE
• 1 part time practice nurse 0.69 WTE
• 1 cleaner 0.21 WTE

The practice is open from 8:30am to 6:30pm. The practice has a contract with another practice to provide emergency cover between the hours of 8am and 8.30am. Out of hours services are accessible via NHS 111. Information about how patients can access these services is available on the practice’s website and at the practice’s entrance. Extended services are offered on Wednesdays from 6.30am to 7pm and once a month on a Saturday. In addition to pre-bookable appointments, same day appointments and telephone consultations are available.

The practice is committed about training and supporting the next generation of doctors. The practice has been in the third year of being a training practice and is also supporting 6th form students with work experience placements. The practice had one GP trainee at the time of our inspection.

Updated 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakhill Surgery on 19 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• People’s emotional and social needs were seen as important as their physical needs. The practice had a carers champion, a domestic violence champion and a member of the reception team was planning to become a health connector champion.
• The GP patient survey results and feedback from patients suggested that people were respected and treated as individuals.

The areas where the provider should make improvements are:

• Ensure that all medicines fridges’ temperature are checked and recorded daily. Records should include actual, minimum and maximum temperatures.

• To monitor and record that all identified actions are completed in response to significant events.

• Ensure that patients have an appointment booked with secondary care services when referred under the 2 week appointment process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice nurse had the lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed. Patients with a diagnosis of diabetes were given a 20 minute consultation with the GP and nurse annually. Care plans were discussed and reviewed and copies of these were given to the patients.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice offered additional home visits and telephone calls to frail and vulnerable patients to give them extra support. The practice had a weekly list of patients who were contacted or visited as required.
• Care plans were completed for the most vulnerable patients such as those on the unplanned hospital admissions register and on the palliative care register.

Updated 21 November 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 88%, which was comparable to the CCG average of 81% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 6 week baby checks were offered to all new mothers and their babies. The practice sent a letter offering this service and also congratulating them on the birth of their baby.
• The practice had baby changing facilities and a room and private area for mothers who would like to breast feed away from the public area.
• The practice offered coils and implant service as an enhanced service as well as contraceptive pill checks and cervical smears tests.
• The GPs ran surgeries three times weekly at a local school.
• Confidential contraceptive service was offered to teenagers.
• GPs had attended nursery and play groups to familiarise young children with doctors.

Updated 21 November 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Rather than reacting to emergencies the practice had created a chronic visiting list whereby they regularly review patients who are considered to be vulnerable in a proactive way. Practice provided older housebound patients annual flu vaccines as another method of keeping in touch with them.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice delivered prescriptions to patients who were frail or housebound as an extra service.
• Patients received a medicine reviews every six months.
• The practice provided care for terminally ill patients and endeavour to, where possible, provide out of hours care for patients they had worked closely as a way of supporting them, their families and the district nursing team.

Updated 21 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Online access was offered for appointment booking, cancellation, patient record summary and ordering of prescriptions.
• Extended hours services were offered on Wednesdays from 6.30am to 7pm and once a month on a Saturday.
• Telephone consultations were offered for all patients but those working may have chosen this as a more convenient option to them.

Updated 21 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with a diagnosis of a dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice prioritised continuity of care to patients experiencing mental health problems.
• The practice facilitated the use of their facilities to social services, health connectors and counsellors free of charge, in order to give patients the opportunities to see these professionals in a convenient venue to them.

Updated 21 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances and offered additional contact with the practice as determined on an individual basis. For example for chronic disease management or regarding a mental health episode which could be via telephone call, consultation, safeguarding meetings or home visits.
• The practice offered longer appointments and annual learning disability checks for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Monthly meetings took place with Central Mendip practices whereby GPs attend from the 3 practices, alongside with other health professionals such as district nurses, consultant geriatrician and health connection staff in order to discuss vulnerable patients and to implement care plans.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• Patients whom the practice determined as vulnerable were discussed monthly at the practice’s clinical team meetings which involved the GPs, nurse, health care assistant and the practice manager discussing the patients. Actions resulting from these discussions were then followed up and alerts were placed on the electronic patient record system to highlight this to all clinicians.
• The practice had a domestic violence champion which was an informal role that the practice had adopted. This role was undertaken by the practices health care assistant (HCA).The HCA was a point of reference for the clinical team, they signposted patients and provided supporting information such as leaflets and details of helplines and support groups.